Trends and outcomes in primary health care expenditures in low-income and middle-income countries, 2000–2017

Abstract

IntroductionAs the world responds to COVID-19 and aims for the Sustainable Development Goals, the potential for primary healthcare (PHC) is substantial, although the trends and effectiveness of PHC expenditure are unknown. We estimate PHC expenditure for each low-income and middle-income country between 2000 and 2017 and test which health outputs and outcomes were associated with PHC expenditure.MethodsWe used three data sources to estimate PHC expenditures: recently published health expenditure estimates for each low-income and middle-income country, which were constructed using 1662 country-reported National Health Accounts; proprietary data from IQVIA to estimate expenditure of prescribed pharmaceuticals for PHC; and household surveys and costing estimates to estimate inpatient vaginal delivery expenditures. We employed regression analyses to measure the association between PHC expenditures and 15 health outcomes and intermediate health outputs.ResultsPHC expenditures in low-income and middle-income countries increased between 2000 and 2017, from $41 per capita (95% uncertainty interval $33–$49) to $90 ($73–$105). Expenditures for low-income countries plateaued since 2014 at $17 per capita ($15–$19). As national income increased, the proportion of health expenditures on PHC generally decrease; however, the fraction of PHC expenditures spent via ambulatory care providers grew. Increases in the fraction of health expenditures on PHC was associated with lower maternal mortality rate (p value≤0.001), improved coverage of antenatal care visits (p value≤0.001), measles vaccination (p value≤0.001) and an increase in the Health Access and Quality index (p value≤0.05). PHC expenditure was not systematically associated with all-age mortality, communicable and non-communicable disease (NCD) burden.ConclusionPHC expenditures were associated with maternal and child health but were not associated with reduction in health burden for other key causes of disability, such as NCDs. To combat changing disease burdens, policy-makers and health professionals need to adapt primary healthcare to ensure continued impact on emerging health challenges.

Costs and resource needs for primary health care in Ethiopia: evidence to inform planning and budgeting for universal health coverage

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An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria

“…Comparing state-level estimates with national figures for Nigeria is challenging since national data likely conceal substantial state-level variation. Per capita PHC cost estimates for Nigeria estimated by the Institute for Health Metrics and Evaluation (IHME) and the World Health Organization (WHO) ranged from US$ 31 in 2017 ( 43 ) to US$ 40 in 2020 ( 11 ). Although most of our estimates for Kaduna and Kano are lower, the IHME and WHO base their calculations on country-reported health expenditures that include components not considered in our study, including above service-level overheads and spending at private providers ( 43 ).…”

Capacity and quality of maternal and child health services delivery at the subnational primary healthcare level in relation to intermediate health outputs: a cross-sectional study of 12 low-income and middle-income countries

“…More recent efforts by Randhawa4 and Veillard et al 5 have demonstrated the relationship between inputs and outcomes of the PHC system. Previous studies also highlighted that PHC capacity, including the availability of providers, governance and financing, has been found to impact PHC-related outcomes in LMICs at the national level 6–10. In addition, several studies have identified relationships between elements of high-quality PHC and performance at the national level 2 11–14.…”